An innovative approach in the treatment of nodular adenomyosis

   Introduction. The necessity to improve methods of adenomyosis treatment is determined not only by its high prevalence, which reaches 40 % among women of reproductive age, but also by its association with infertility of unclear genesis. The disease significantly reduces the quality of life.   Objective. To optimize reproductive outcomes after surgical treatment of nodular adenomyosis and to prevent the disease recurrence.   Materials and Methods. A cohort prospective comparative study examined the efficacy of therapy with dienogestam after laparoscopic removal of adenomyosis nodules with temporary uterine artery occlusion and temporary balloon occlusion of the internal iliac arteries. The study included 25 women who underwent organ-preserving treatment for nodular adenomyosis from January 1, 2020 to January 1, 2022. Inclusion criteria: age 22–45 years, mean 32 ± 4.5; organ preserving treatment for nodular adenomyosis, no contraindications to hormone therapy, informed voluntary consent of the patient to participate in the study.   Results. The use of Dientogest at a dose of 2 mg/day in a continuous regimen for 6 months after surgical treatment for nodular adenomyosis was shown to transform the intensity of pain syndrome to insignificant, the absence of recurrent disease for 24 months of follow-up.   Conclusions. The comprehensive treatment of nodular adenomyosis, which included laparoscopic removal of the nodule and the drug therapy with dienogestam, permitted the achievement of reproductive function in 40% of the patients. The choice of the treatment method for nodular adenomyosis depends primarily on the reproductive plans of the patient, the size and location of the adenomyosis nodules, and its long-term results depend on the comprehensive antiretroviral therapy.